RSS-Feed abonnieren
DOI: 10.1055/s-0041-1742205
Revisiting Lunotriquetral Arthrodesis in Chronic Lunotriquetral Ligamentous Injuries
![](https://www.thieme-connect.de/media/jws/202206/lookinside/thumbnails/10-1055-s-0041-1742205_2100070cra-1.jpg)
Abstract
Background Chronic lunotriquetral (LT) ligament tears are a source of ulnar-sided wrist pain. Left untreated, complete tears of the LT ligament may progress to a volar intercalated segment instability deformity and eventual carpal arthritis. Various treatments have been proposed, one of which is LT arthrodesis. LT arthrodesis has been criticized for high rates of nonunion frequently requiring reoperation, and therefore has largely fallen out of favor. However, our experience has been quite different from the literature. This study examines a single surgeon's experience with LT arthrodesis over a 15-year period.
Methods A retrospective review of the senior author's practice over a 15-year period was performed. All adult cases of LT arthrodesis for chronic LT injuries were included. Headless compression screw and cancellous bone graft from the distal radius were used for primary arthrodesis in all cases. The primary outcome was rate of union, and secondary outcomes were time to union, secondary or salvage procedures, and range of motion. Nonparametric statistical analysis was used to calculate differences in outcomes.
Results Twenty-eight patients met inclusion criteria. The median age was 45.5 (interquartile range [IQR] 35–50) years and 75% were male. The dominant hand was most commonly affected. Eighty-six percent of patients achieved union, one patient required redo arthrodesis, and one patient went on to wrist salvage. Three patients developed a pain-free pseudoarthrosis. Median time to radiographic union was 8.8 (IQR 5.9–11.9) weeks.
Conclusion Despite multiple previous reports, this study demonstrates that LT arthrodesis for chronic LT injuries is a safe technique with high rates of successful union. Further comparative studies are warranted to determine the optimal treatment for chronic LT injuries.
Publikationsverlauf
Eingereicht: 29. Mai 2021
Angenommen: 09. Dezember 2021
Artikel online veröffentlicht:
24. Januar 2022
© 2022. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Sachar K. Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg Am 2012; 37 (07) 1489-1500
- 2 Nicoson MC, Moran SL. Diagnosis and treatment of acute lunotriquetral ligament injuries. Hand Clin 2015; 31 (03) 467-476
- 3 Reagan DS, Linscheid RL, Dobyns JH. Lunotriquetral sprains. J Hand Surg Am 1984; 9 (04) 502-514
- 4 Ritt MJ, Bishop AT, Berger RA, Linscheid RL, Berglund LJ, An KN. Lunotriquetral ligament properties: a comparison of three anatomic subregions. J Hand Surg Am 1998; 23 (03) 425-431
- 5 Wagner ER, Elhassan BT, Rizzo M. Diagnosis and treatment of chronic lunotriquetral ligament injuries. Hand Clin 2015; 31 (03) 477-486
- 6 Sammer DM, Rizzo M. Ulnar impaction. Hand Clin 2010; 26 (04) 549-557
- 7 Kirschenbaum D, Coyle MP, Leddy JP. Chronic lunotriquetral instability: diagnosis and treatment. J Hand Surg Am 1993; 18 (06) 1107-1112
- 8 Atkinson CT, Watson J. Lunotriquetral ligament tears. J Hand Surg Am 2012; 37 (10) 2142-2144
- 9 Shin AY, Weinstein LP, Berger RA, Bishop AT. Treatment of isolated injuries of the lunotriquetral ligament. A comparison of arthrodesis, ligament reconstruction and ligament repair. J Bone Joint Surg Br 2001; 83 (07) 1023-1028
- 10 Sennwald GR, Fischer M, Mondi P. Lunotriquetral arthrodesis. A controversial procedure. J Hand Surg 1995; 20 (06) 755-760
- 11 Vandesande W, De Smet L, Van Ransbeeck H. Lunotriquetral arthrodesis, a procedure with a high failure rate. Acta Orthop Belg 2001; 67 (04) 361-367
- 12 McAuliffe JA, Dell PC, Jaffe R. Complications of intercarpal arthrodesis. J Hand Surg Am 1993; 18 (06) 1121-1128
- 13 Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 1996; 78 (03) 357-365
- 14 Larsen CF, Mathiesen FK, Lindequist S. Measurements of carpal bone angles on lateral wrist radiographs. J Hand Surg Am 1991; 16 (A): 888-893
- 15 Parker AS, Nguyen M, Minard CG, Guffey D, Willis MH, Reichel LM. Measurement of ulnar variance from the lateral radiograph: a comparison of techniques. J Hand Surg Am 2014; 39 (06) 1114-1121
- 16 Guidera PM, Watson HK, Dwyer TA, Orlando G, Zeppieri J, Yasuda M. Lunotriquetral arthrodesis using cancellous bone graft. J Hand Surg Am 2001; 26 (03) 422-427
- 17 Pin PG, Young VL, Gilula LA, Weeks PM. Management of chronic lunotriquetral ligament tears. J Hand Surg Am 1989; 14 (01) 77-83
- 18 Nelson DL, Manske PR, Pruitt DL, Gilula LA, Martin RA. Lunotriquetral arthrodesis. J Hand Surg Am 1993; 18 (06) 1113-1120
- 19 De Smet L, Janssens I, van de Sande W. Chronic lunotriquetral ligament injuries: arthrodesis or capsulodesis. Acta Chir Belg 2005; 105 (01) 79-81
- 20 Weiss AP, Sachar K, Glowacki KA. Arthroscopic debridement alone for intercarpal ligament tears. J Hand Surg Am 1997; 22 (02) 344-349
- 21 Westkaemper JG, Mitsionis G, Giannakopoulos PN, Sotereanos DG. Wrist arthroscopy for the treatment of ligament and triangular fibrocartilage complex injuries. Arthroscopy 1998; 14 (05) 479-483
- 22 Shin AY, Bishop AT. Treatment options for lunotriquetral dissociation. Tech Hand Up Extrem Surg 1998; 2 (01) 2-17
- 23 Shahane SA, Trail IA, Takwale VJ, Stilwell JH, Stanley JK. Tenodesis of the extensor carpi ulnaris for chronic, post-traumatic lunotriquetral instability. J Bone Joint Surg Br 2005; 87 (11) 1512-1515
- 24 Omokawa S, Fujitani R, Inada Y. Dorsal radiocarpal ligament capsulodesis for chronic dynamic lunotriquetral instability. J Hand Surg Am 2009; 34 (02) 237-243